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The effect of Clarke’s angle variability on the static and dynamic balance of different sports

  • I Putu Juniartha ,
  • Damayanti Tinduh ,
  • Dyah Intaniasari ,
  • I Putu Alit Pawana ,
  • Soenarnatalina Melaniani ,


Background: Flatfoot affects postural control by altering the biomechanics of the lower limb, sensory input, and proprioception. Poor static and dynamic balance can influence the physical performance of competitive sports athletes and increase the risk of lower limb injury. Footprint analysis using Clarke’s angle (CA) is easy to perform and has good diagnostic performance as an alternative flatfoot assessment for a large athlete population. Our study aims to determine the effect of CA variability on the static and dynamic balance of different sports using the one-leg stance (OLS) and star excursion balance test (SEBT).

Methods: This is an analytic observational study with a retrospective cohort design. Medical record data from 209 athletes’ feet from 11 sports were collected to determine the subjects’ characteristics and research variables. Curve estimation and regression tests were performed to assess the effect of CA variability on the OLS and normalized reach distance of SEBT (NSEBT).

Results: The mean CA of all athletes was 44.82±11.14o. The mean time of OLS of all athletes was 47.78±40.54 seconds. The least and the farthest average normalized reach distance was done in the anterolateral direction (79.06±11.88 %) and posterior direction (93.45±18.98 %). There is no effect of CA variability on the OLS of all sports, male and female athletes. There is an effect of CA variability on the OLS of Wushu athletes, also on the NSEBT of whole athletes (lateral, posterolateral, posterior, posteromedial directions; male athletes (posterolateral direction); female athletes (anteromedial direction); and different sports, includes athletic (anterolateral, lateral, posterolateral, posterior, posteromedial, medial, anteromedial direction); fencing (anterolateral direction); and running (anterolateral, lateral, posterior, posteromedial, medial, anteromedial, composite directions).

Conclusion: Clarke’s angle variability significantly affects the static balance of Wushu athletes and the dynamic balance of athletes in athletics, fencing, and running.


  1. Neumann D. Kinesiology of The Musculoskeletal System: Foundation for Rehabilitation. 2nd Ed. London: Spring Books. 2010.
  2. Henry JK, Shakked R, Ellis SJ. Adult-Acquired Flatfoot Deformity. Foot Ankle Orthop. 2019;4(1):2473011418820847.
  3. Aenumulapalli A, Kulkarni MM, Gandotra AR. Prevalence of Flexible Flat Foot in Adults: A Cross-sectional Study. J Clin Diagn Res. 2017;11(6):AC17-AC20.
  4. Tahmasebi R, Karimi MT, Satvati B, Fatoye F. Evaluation of Standing Stability in Individuals With Flatfeet. Foot & Ankle Specialist. 2015;8(3):168-174.
  5. Kumala MS, Tinduh D, and Poerwandari D. Comparison of Lower Extremities Physical Performance on Male Young Adult Athletes with Normal Foot and Flatfoot. Surabaya Physical Medicine and Rehabilitation Journal. 2019;1(1). p6-13.
  6. Shin BJ, Lee KM, Chung CY, et al. Analysis of factors influencing improvement of idiopathic flatfoot. Medicine (Baltimore). 2021;100(32):e26894.
  7. Pita-Fernández S, González-Martín C, Seoane-Pillado T, López-Calviño B, Pértega-Díaz S, Gil-Guillén V. Validity of footprint analysis to determine flatfoot using clinical diagnosis as the gold standard in a random sample aged 40 years and older. J Epidemiol. 2015;25(2):148-154.
  8. Hertel J, Gay MR, Denegar CR. Differences in Postural Control During Single-Leg Stance Among Healthy Individuals With Different Foot Types. J Athl Train. 2002;37(2):129-132.
  9. Michelson JD, Durant DM, McFarland E. The injury risk associated with pes planus in athletes. Foot Ankle Int. 2002;23(7):629-633.
  10. Juniartha IP, Tinduh D, Nugraheni N, Pawana IPA, Setiawati R, and Melaniani S. The validity and reliability of various footprint analysis in flatfoot diagnosis of competitive athletes. Bali Medical Journal. 2023;12(1). p851–856.
  11. Hertel J, Miller SJ, and Denegar CR. Intratester and intertester reliability during the star excursion balance tests. Journal of Sport Rehabilitation. 2000;9(2). p104–116.
  12. Hahn T, Foldspang A, Vestergaard E, and Ingemann-Hansen T. One-leg standing balance and sports activity. Scandinavian Journal of Medicine and Science in Sports. 1999;9(1). p15–18.
  13. Dingenen B, Janssens L, Claes S, Bellemans J, Staes FF. Lower extremity muscle activation onset times during the transition from double-leg stance to single-leg stance in anterior cruciate ligament reconstructed subjects. Clin Biomech (Bristol, Avon). 2016;35:116-123.
  14. Troester JC, Jasmin JG, Duffield R. Reliability of Single-Leg Balance and Landing Tests in Rugby Union; Prospect of Using Postural Control to Monitor Fatigue. J Sports Sci Med. 2018;17(2):174-180.
  15. Alonso AC, Brech GC, Bourquin AM, Greve JM. The influence of lower-limb dominance on postural balance. Sao Paulo Med J. 2011;129(6):410-413.
  16. Huang HC, Wu WL, Chang YK, Chu IH. Physical fitness characteristics of adolescent wushu athletes. J Sports Med Phys Fitness. 2018;58(4):399-406.
  17. Ostad MS, Norasteh AA, and Samakoush HB. Comparison of Static and Dynamic Balance of Athletes of Different Sports in Conditions With and Without Posture Disturbances. Journal of Sport Biomechanics. 2019;4(4). p16–27.
  18. Vuillerme N, Danion F, Marin L, et al. The effect of expertise in gymnastics on postural control. Neurosci Lett. 2001;303(2):83-86.
  19. Dabholkar A, Shah A, and Yardi S. Comparison of Dynamic Balance Between Flat Feet and Normal Individuals Using Star Excursion Balance Test. Indian Journal of Physiotherapy and Occupational Therapy - An International Journal. 2012;6(3). p27–31.
  20. Alnahdi AH, Alderaa AA, Aldali AZ, Alsobayel H. Reference values for the Y Balance Test and the lower extremity functional scale in young healthy adults. J Phys Ther Sci. 2015;27(12):3917-3921.
  21. Sabin MJ, Ebersole KT, Martindale AR, Price JW, Broglio SP. Balance performance in male and female collegiate basketball athletes: influence of testing surface. J Strength Cond Res. 2010;24(8):2073-2078.
  22. Gribble PA, Robinson RH, Hertel J, Denegar CR. The effects of gender and fatigue on dynamic postural control. J Sport Rehabil. 2009;18(2):240-257.
  23. Bhat R, Moiz JA. Comparison of dynamic balance in collegiate field hockey and football players using star excursion balance test. Asian J Sports Med. 2013;4(3):221-229.
  24. Gabriela V, Rafael G, Felipe M, Cláudia L. Effects of proprioceptive training on ankle muscle strength in fencers: A clinical trial. J Bodyw Mov Ther. 2021;27:141-147.
  25. Paillard T, Costes-Salon C, Lafont C, Dupui P. Are there differences in postural regulation according to the level of competition in judoists?. Br J Sports Med. 2002;36(4):304-305.
  26. Adigüzel N. Education of star excursion balance performance among young male athletes. Afri Edu Res Jour. 2020;8(2). p147–151.
  27. Gruber M, Gruber SB, Taube W, Schubert M, Beck SC, Gollhofer A. Differential effects of ballistic versus sensorimotor training on rate of force development and neural activation in humans. J Strength Cond Res. 2007;21(1):274-282.
  28. Matthews MJ. Traditional Martial Arts Training Enhances Balance and Neuromuscular Control in Female Modern Martial Artists. Journal of Yoga & Physical Therapy. 2016;06(1). p1-5.
  29. Bressel E, Yonker JC, Kras J, Heath EM. Comparison of static and dynamic balance in female collegiate soccer, basketball, and gymnastics athletes. J Athl Train. 2007;42(1):42-46.
  30. Anat L. The Association between Foot Morphology and Dynamic Balance Performance as Measured by the Star Excursion Balance Test. Journal of Exercise, Sports & Orthopedics. 2015;2(3). p01–07.

How to Cite

Juniartha, I. P., Tinduh, D., Intaniasari, D., Pawana, I. P. A., & Melaniani, S. (2023). The effect of Clarke’s angle variability on the static and dynamic balance of different sports. Bali Medical Journal, 12(3), 3436–3442.




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I Putu Juniartha
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Damayanti Tinduh
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Dyah Intaniasari
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I Putu Alit Pawana
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Soenarnatalina Melaniani
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